chronic appendicitis
Introduction
Introduction to chronic appendicitis Chronic appendicitis refers to chronic inflammatory lesions of the appendix left after the acute inflammation of the appendix subsides, such as fibrous connective tissue hyperplasia, stenosis or occlusion of the lumen, distorted appendix, and adhesion to surrounding tissues. Diagnosis of chronic appendicitis is not easy, and its diagnosis must be based on the exclusion of all right lower abdomen pain and tenderness diseases, so the diagnosis of chronic appendicitis should be cautious. No obvious or irregular pain in the right lower abdomen is the main clinical manifestation. Occasionally, other gastrointestinal symptoms such as increased frequency of bowel movements or abdominal fullness, etc., mild tenderness in the right lower abdomen is the main sign. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: peritonitis abscess
Cause
Causes of chronic appendicitis
Stenosis of the appendix wall (30%):
If you have had acute appendicitis before, after the medication is cured, the wall of the appendix will make the wall of the appendix smaller. At the same time, it can also weaken the peristaltic function of the appendix. This is one of the causes of appendicitis.
Conductor in the appendix cavity (30%):
The guides in the appendix cavity are prone to the appearance of appendicitis, such as fecal masses, small fruit nuclei, and aphids, which are also the causes of appendicitis.
Lymphoid tissue enlargement (10%):
The etiology of appendicitis is related to the swelling of lymphoid tissue on the wall of the appendix. Appendicitis tumors can also cause obstruction, which is one of the causes of appendicitis. There are many bacteria in the appendix cavity, which may cause inflammation of appendicitis after obstruction, causing thrombosis. Blocking blood vessels, causing necrosis, infection and disease.
Pathogenesis
Although some people think that the pathology of chronic inflammation of the appendix is sometimes not easy to be confirmed, most of them still have a clear change. The appendix wall is hypertrophic and hypertrophic. It is fibrotic and short and tough, the surface is grayish white, the appendix is thickened, shortened and hardened, and the mucosa or There are infiltration of perivascular lymphocytes and eosinophils under the subserosal membrane, and some foreign bodies can also be seen. Sometimes the fibrosis of the appendix wall leads to narrowing of the lumen, and even occlusion into a cord is similar to the aging of the appendix, stenosis and occlusion. The tip of the appendix spreads to the root. If only the root is occluded, the distal lumen can be filled with mucus to form a mucous cyst. The chronic inflammation of the appendix can be curled by itself, or surrounded by a large amount of fibrous adhesion. There are feces or other memory in the lumen. foreign matter.
Prevention
Chronic appendicitis prevention
Prevention of appendicitis, usually develop good hygiene habits, pay attention to diet adjustment, eat less meals, avoid overeating, do not exercise immediately after meals.
There is not much contraindication to the chronic appendicitis diet. If the abdominal pain occurs, see the surgery in time.
Chronic appendicitis drugs can only be relieved, can not be cured, since it is chronic, it may recur before the cure, and the possibility of recurrence is very large, it will recur, otherwise it is not called chronic appendicitis, it can also relapse during pregnancy Can lead to gynecological pelvic inflammatory disease, surgical treatment is the only method, must be further confirmed by barium enema angiography before surgery.
Complication
Chronic appendicitis complications Complications peritonitis abscess
A small number of complications occur due to untimely treatment or low body resistance. The most common complications are peritonitis caused by perforation of the appendix and abscess around the appendix. For example, thrombophlebitis of the appendicular mesenteric vein may be accompanied by bacteria or bacteria-containing thrombus. Intravenous reflux into the liver to form a liver abscess, if the root of the appendix is blocked, the mucous membrane secretion secreted by the mucosal epithelium causes the appendix to be highly inflated. The appendix mucus cyst or the suppuration is called appendix empyema. The mucous cyst penetrates the appendix wall, and the mucous epithelium and mucus enter the abdominal cavity. Post-planting on the surface of the peritoneum can form a pseudo-myxoma of the abdominal cavity.
Symptom
Chronic appendicitis symptoms Common symptoms Lower abdominal cramps Abdominal pain Diarrhea Bloating Swollen appendix Ischemia Congestion Sensation Abscess Appetite stagnation Tail cavity occlusion rib bulge
Chronic appendix lacks typical clinical manifestations, which can cause many causes of pain and tenderness in the right lower quadrant. The following points should be noted for the diagnosis of chronic appendicitis:
1, the history of typical acute appendicitis repeated the author's previous acute appendicitis lesions are more serious, the history of the inquiry should have a typical history of acute appendicitis, such as a history of appendicitis abscess or inflammatory mass, the diagnosis value is greater.
2, there are repeated episodes of right lower quadrant pain and tenderness, thickening of the appendix wall, stenosis of the lumen, obstruction of emptying is easy to induce acute infection or residual infection, often causing lower right abdominal pain and tenderness, chronic appendicitis should cause abdominal pain and tenderness The same as in the past with acute appendicitis, only to a certain extent.
3, X-ray barium meal examination This is a very important examination, especially in the absence of a typical history of seizures, barium meal examination can not only be clear that the tender point is located at the appendix, other lesions can be ruled out, the X-ray signs of chronic appendicitis are appendix development There is interruption, distortion, slow emptying, and it is difficult to push due to adhesion. If the appendix cavity is completely occluded, it will not be developed. The relationship between the tender point and the appendix can be judged according to the position of the ileocecal development.
Examine
Chronic appendicitis examination
Gastrointestinal sputum and fiberoptic angiography are helpful. The ileocecal sputum shows tenderness in the appendix, the appendix is segmented, the sputum emptying time in the appendix cavity is extended, and the appendix is not developed. Characteristics of chronic appendicitis.
The fiberoptic colonoscopy can directly observe the changes and biopsy of the opening of the appendix and its surrounding mucosa, and can still be used for angiography of the appendix cavity, which has certain significance for differential diagnosis.
Blood routine examination, white blood cells can be normal or slightly higher, in acute attacks, white blood cells increased significantly, and the proportion of neutrophils increased.
1. X-ray barium enema examination: It can be seen that the appendix development is interrupted, distorted, slowed out, and difficult to be pushed due to adhesion. If the appendix cavity is completely occluded, it will not be developed. This test is important for those who have no typical episode history. Significance, barium enema examination can not only confirm that the tender point is located at the appendix, but also to exclude other diseases that can be confused with chronic appendicitis, such as ulcer disease, chronic colitis, cecal tuberculosis or cancer, visceral drooping.
2. Ultrasonography: It is also important to exclude chronic cholecystitis, chronic obstructive inflammation and chronic urinary tract infections that are most likely to be confused with chronic appendicitis.
About 35% of the patients diagnosed with chronic appendicitis had no improvement in postoperative symptoms, and all other diseases were misdiagnosed as chronic appendicitis. It is obvious that the rate of misdiagnosis is high and the preoperative differential diagnosis is important.
Diagnosis
Diagnosis and diagnosis of chronic appendicitis
diagnosis
Diagnosis of chronic appendicitis is not easy, and its diagnosis must be based on the exclusion of all right lower abdomen pain and tenderness diseases, so the diagnosis of chronic appendicitis should be cautious.
No obvious or irregular pain in the right lower abdomen is the main clinical manifestation. Occasionally, other gastrointestinal symptoms such as increased frequency of bowel movements or abdominal fullness, etc., mild tenderness in the right lower abdomen is the main sign.
Repeated (intermittent) episodes of appendicitis have a clear history of acute appendicitis, followed by intermittent recurrent episodes, but all of them are subacute, often have reflex stomach discomfort, abdominal distension, constipation and other symptoms, more certainly right Lower abdominal pain and local tenderness are not serious. After multiple episodes, the right lower abdomen can also reach the appendix of the appendix, which is painful to the touch. Therefore, it is easy to identify clinically. As for the history of acute appendicitis, the history is unclear. Symptoms and signs are not typical, the diagnosis is difficult, patients often have frequent right lower quadrant cramps, the degree of pain is different, most of them are dull pain, usually have more symptoms of gastrointestinal diseases, such as loss of appetite, bloating, eating After the stomach discomfort, constipation or mild diarrhea, etc., have no characteristics, more and more concentrated clinical manifestations or right lower quadrant pain and tenderness, involving a wide range, but still centered on the appendix.
For patients with a history of acute appendicitis, repeated (intermittent) episodes of appendicitis with obvious signs and symptoms, the diagnosis is not difficult, but for chronic (obstructive) appendicitis without a history of acute appendicitis, a clear diagnosis is a key problem, barium enema The examination is helpful. The most typical finding is that the tincture is filled with the appendix. It is found that the appendix is narrow and irregular, irregularly filled, twisted, fixed, and can be tenderly developed. The appendix has obvious tenderness, sometimes the appendix is not full or only partially filled. Local tenderness can also be considered as the performance of chronic appendicitis. In addition, although the filling of the appendix is normal, the emptying delay is more than 48h, which can also be used as a diagnostic reference.
Differential diagnosis
And chronic appendicitis need to distinguish between gynecological attachment inflammation, usually accompanied by abdominal pain, increased vaginal discharge, mostly pain, if the pain for many years, the site is not obvious, and lack of visceral dysfunction, when the time, most may be Functional pain, ureteral stones sometimes manifest as chronic abdominal pain, intestinal fistula, colitis and sometimes chronic pain.
